Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-71

INSULIN PUMP THERAPY (CSII)

Before beginning pump therapy, patients might do well to attempt intensive management using another approach first. This provides a “testing ground” for the person and health-care professionals to evaluate his or her capacity for self-management and ability to engage in diabetes self-care behaviours, including frequent self-monitoring, insulin adjustment and understanding of meal-planning principles. Pump therapy may not be for everyone. For people with no available coverage, it is more expensive than BBI (89). For patients who have not fully accepted their disease, its use may present an unacceptable “statement” about having diabetes. The pump cannot be hidden during some sports or intimate moments. It is important to explain to individuals that the pump can come off for periods of time in certain situations. Selection of patients • There are a number of advantages of pump therapy for patients: o Pump therapy eliminates the unpredictable absorption of intermediate-acting insulin. o Precise insulin dosing: For example, basal rates can be programmed in increments of 0.025 units, and bolus doses can be given in increments of 0.05 units. o The person has the ability to meet basal insulin demands over the course of 24 hours to deal with his or her distinct basal insulin requirements (e.g. significant dawn effect). o Pump therapy can reduce the frequency of severe hypoglycemia (133). o Pump therapy may be preferable when the person has a highly variable schedule from day to day or during the day (73). o Pump therapy can provide improved control during exercise; the person can make immediate adjustments for unplanned activity. • The clinical indications for pump therapy are as follows: o Frequent or severe hypoglycemia. o Pronounced dawn effect. o Low daily insulin requirements.